Basic Information
| Provider Information | |||||||||
| NPI: | 1386080182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAPALA | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PERRON | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 108 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | BATH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045302550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073861800 | ||||||||
| FaxNumber: | 2073861801 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | BATH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045302550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073861800 | ||||||||
| FaxNumber: | 2073861801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | DO 2625 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.